Challenge to The Massage Profession:
I am writing this letter after 17 years of being in full time practice in
Seattle WA. WA State has been the leader in creating
licensing and legislation
and is now in the forefront of the insurance billing issues that
massage therapists are faced with. The profession is at a major tuning point of
being accepted by the medical profession and the insurance industry. The
future depends on how we as a profession define "massage" and
so-called "medical massage".
The "Every Category Law" allows us
to become contracted providers with insurance networks. We are one of two states
that mandates that alternative therapies such as massage, acupuncture and
naturopathy be We are able to bill
health insurance companies along with the usual automobile insurance companies and Labor &
Industries for our services.
This acceptance by the insurance industry and the medical profession brings
with it a double edged sword. On one hand, we want our work to be accepted and
understood. We want to be able to provide our clients with this service and
build a profitable and successful practice. On the other hand comes the issues
of having the insurance networks determine our standards of practice which is
currently happening in WA State!!!!
Here are the facts that are currently happening in WA State:
- American Whole Health Network is creating ( www.wholehealthpro.com)
a Certified Medical Practitioners "certification" that will require massage
therapists to have additional education to be able to be a contracted
provider. They are defining "medical massage"
themselves. Massage therapists have little say in this at this time. This is one way the networks are limiting
the number of therapists in the network and the money they will
have to pay out to massage therapists.
This means that the health
insurance networks are setting )
Automobile Insurance companies are becoming members of these networks
which means that we are being paid a reduced fee for our services by
automobile insurance companies while we
were at one time able to get the amount that we charged. The UCR for
Seattle is $132 the last time I checked. I personally think that is
too high and it is high time that the insurance companies woke up, but when
they pay us less what we charge our cash clients which in the Seattle area
is $60-$85 per hour depending on the area (by my guess).
We are being asked to prove medical necessity. Claims are being denied
based on whether or not it is medically necessary yet we don't have any
definition or any idea of what criteria the insurance companies use to
determine medical necessity. From what I understand, medical necessity
is determined by the physicians, yet our chart notes are needed to show what
we do.
Our allowable fees are constantly being greatly reduced to less than our
fees for services (by $20.00 - $70).
We are restricted in our use of CPT codes by some insurance companies,
while others will pay for more. (We can only use 97124 with one company,
while another will pay for 97140 and 97112.) What code is allowed
depends on how your individual state defines massage. If massage is
defined only as 'effleurage etc. that is all you will be able to
do. Myofascial release and manual therapy are not allowed if your
definition does not include it. (This is from what I understand about
this so far. If anyone has a better idea of what is going on, please
let me know.)
Insurance plans are being written that depend on our ability to prove
medical necessity. Treatments are discontinued and in some cases, patients are not allowed to
ever be treated for "back pain" again during the life of their
policy.
We are having to work more hours because we are being paid less.
There is more paperwork and phone calling involved in order to get paid.
Billing insurance companies for our services is no longer profitable.
Licensed Acupuncturists are already having their scope of practice defined
by the insurance companies restricting their ability to treat other
conditions except for pain. (One company will only allow acupuncturists to
treat pain conditions, while their scope of practice allows for much more.)
What this means for us is that we need to protect our scope of practice.
The insurance industry consistently reduces coverage for massage therapy
benefits. (Allowable benefits have been drastically cut for their
participating members. Policies that once allowed for $2,500 worth of
rehabilitation therapy has been reduced to $1000 or less. This I know from
my personal experience as a consumer of health insurance. We all know that
if someone really has a serious back injury that $1000 worth of massage or
Physical therapy will not take care of the problem.)
After attending a panel discussion group put on by the AMTA-WA here in Seattle on the meaning of
credentialing by the insurance networks, I learned that the insurance companies
are doing this basically ‘because they can".
Our profession has yet to declare what we stand for or what we want. We have
not been able to step up and define "medical massage" nor determine what we want
our role to be when working with the medical profession.
I believe that we need to even take it a step farther and determine if we
want to be a part of the so-called medical profession and participate in such
networks.
Do we want to work with a system of health care that is attempting to define
our profession?
Do we want to participate in networks that have already forced medical
doctors out of practice?
Do we really want to be paid less and less for what we do?
How can we create our own health care system model that incorporates our
beliefs about healing?
How can we prove that the therapeutic relationship is what heals and not any
technique that we do? How can we prove that it is the power of touch that heals
and our ability to educate (draw forth) the client in the process of healing?
How can we define our profession and create a definition of "medical
massage" that includes all therapy? (Who are we to say what is or
isn't therapy?)
My challenge to the profession is to step up and create a definition of
massage that incorporates ALL healing touch modalities including relaxation
massage. We have the opportunity to co-create our profession rather than just
accepting what is handed to us. The dilemma is driven by politics and economics.
The insurance networks bottom line it to make money while serving its members.
What is our bottom line? How much will we take before we realize that the
insurance networks are creating and defining our profession?
I am not sure what the answer is...how to make the insurance companies listen
or what do we need to do to clarify our intent and mission as a whole...
The Every Category Law:
http://www.insurance.wa.gov/factsheets/factsheet_detail.asp?FctShtRcdNum=54
http://www.insurance.wa.gov/factsheets/factsheet_detail.asp?FctShtRcdNum=55
RCW 48.43.005- The Every Category Law
